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A fear reaction is fundamental for survival and naturally activates the adrenergic system, prompting an acute and vital flight-or-fight response. While sustained stress is associated with unhealthy low-grade inflammation, more acute and transient activation of the adrenergic system has been suggested to impact the immune system and subsequently attenuate low-grade inflammation, e.g. through cold exposure or hyperventilation. Voluntary exposure to frightening stimuli, such as scary entertainment, is another reliable activator of the adrenergic system, yet its impact on the immune system and low-grade inflammation is unknown. The objectives of this study are to i. assess proportional changes of participants with low-grade inflammation at and three days after a voluntary frightening event, and ii. explore mean value alterations in inflammatory markers and immune cells over time. We recruited adult participants among visitors to a real-life intense frightening haunted house attraction, located in Vejle, Denmark. The overall fright potential of the exposure was estimated through heart rate (HR) monitoring and self-reported levels of fear. Low-grade inflammation (defined as high sensitive C-reactive protein (hs-CRP) > 3 mg/L)) and immune cells (subtypes of leukocytes) were measured from blood samples immediately before, immediately after, and three days after the haunted house event. A total of 113 participants, 69 females (61.1 %), and 44 males (38.9 %), with a mean age of 29.7 (SD 10.1) were included in the analyses. The average duration of exposure was 50 min and 51 s, while the mean HR throughout the event was 111.1 BPM (mean SD 10.1), and the mean subjective reported scare level was 5.4 (SD 1.9) on a Likert scale ranging from 1 to 9. Twenty-two participants exhibited low-grade inflammation (hs-CRP > 3 mg/L) at the event, with 10 participants normalizing their hs-CRP levels three days post-event. Seven participants had normal hs-CRP levels at the event, but low-grade inflammation three days post-event. Thus, we found no proportional difference between participants with low-grade inflammation at the event (19.5 %) and three days after the event (16.8 %) (diff. -2.7 %; 95 % CI: -10.7 to 5.4, p = 0.47). For the 22 participants exhibiting low-grade inflammation at the event, 18 participants (82 %) decreased their hs-CRP levels, with a mean decrease in hs-CRP from 5.7 mg/L pre-event to 3.7 mg/L three days post-event (diff. -2.0, 95 % CI: -3.2 to -0.7, p = 0.003). Supporting an overall attenuation of inflammation, total leukocytes and lymphocytes decreased for both participants with low-grade inflammation and with normal inflammatory levels, when comparing levels pre- and three days post-event, although all mean levels remained within the normal range. Conclusively, we find no proportional differences in participants exhibiting low-grade inflammation (hs-CRP > 3) when comparing levels at and three days after exposure to a voluntary frightening event. However, explorative analyses suggest that recreational fear exposure may attenuate immune cells across the entire cohort (N = 113) and decrease hs-CRP levels for participants who exhibit low-grade inflammation at the event (N = 22)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Preoperative planning in orthopaedic fracture surgery corroborates with the goal of establishing the best possible surgical result and ensuring a functioning limb for the patient. From placing sketches on overhead projector paper and measuring lengths from anatomical landmarks, ways of preoperative planning have evolved rapidly over the last 100 years. Today, preoperative planning includes methods such as advanced 3-Dimensional (3D) printed models and software programs incorporating entire libraries of osteosynthesis materials that can be shaped and rotated to fit a patient's specific anatomy. Relevant literature was evaluated to review the development of preoperative templating from the past and present, in order to assess its impact on the future of osteosynthesis.We identified studies on 3D-imaging, computer-assisted systems, and 3D-printed fractured bones and drill guides. The use of some of these systems resulted in a reduction in operation time, blood loss, perioperative fluoroscopy and hospital stay, as well as better placement of osteosynthesis material. Only few studies have identified differences in patient morbidity and mortality. Future techniques of preoperative templating are on the rise and the potential is vast. The cost-effectiveness and usefulness of certain methods need to be evaluated further, but the benefit of preoperative templating has the potential of being revolutionary, with the possibility of radical advances within orthopaedic surgery., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022. Published by Elsevier Ltd.)

Purpose: We aimed to evaluate the diagnostic and logistical consequences of routine preoperative focused cardiac ultrasound (FOCUS) in patients scheduled for elective vascular surgery., Methods: In a prospective, observational study, FOCUS was performed in all patients seen in the vascular surgery outpatient clinic from January 14 to May1, 2019, unless a full echocardiography had been conducted in the preceding 12 months or the patient was already referred to an echocardiography by the vascular surgeons. FOCUS followed a stringent protocol and referrals for a full echocardiography followed predefined criteria., Results: Preoperative FOCUS was performed in 55 (60%) patients. Of these, 12 patients (22%) revealed cardiac pathology and were referred to a full echocardiography. Coronary angiography was subsequently performed in one of these patients but was without a further consequence. All patients underwent surgery., Conclusion: FOCUS disclosed cardiac pathology in the outpatient clinic but with little clinical consequence. This study does not support routine FOCUS as a part of the preoperative patient cardiovascular assessment before vascular surgery. However, larger studies are warranted to further evaluate the relevance of preoperative FOCUS in a larger sample size., Competing Interests: None., (© 2021 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Objectives: This study was performed to investigate whether an intravenous (IV) strategy based on new-generation midline catheters is an efficacious alternative to a conventional IV strategy consisting of peripheral venous catheters and central venous catheters, for patients needing IV therapy exceeding 5 days., Methods: This was a prospective, randomized, controlled study. Patients requiring more than 5 days of IV treatment were randomized to either a midline catheter-based IV strategy or a conventional strategy. The primary endpoint was the composite of the insertion of a central venous catheter (CVC) or the need for four or more peripheral venous catheter (PVC) insertions. The secondary outcomes included catheter dwell times and reasons for premature removal., Results: One hundred and twenty patients were included. The fraction of patients receiving four or more PVCs or having a CVC inserted was 12/58 (21%) in the midline group versus 38/58 (66%) in the conventional group (p <  0.001); the number needed to treat was 2.2. The median overall catheter dwell time was 7 days (range 0-60 days) in the midline group and 4 days (range 0-84 days) in the conventional group (p =  0.002)., Conclusion: In patients requiring more than 5 days of IV therapy, a midline catheter strategy reduced the need for insertion of a CVC or four or more PVCs., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)